The diagnosis and treatment of any type cancer can create stressful tension in many relationships throughout its time period. In this study, the researchers measured the stress a family endures with a child with cancer or a central nervous system tumor and how it affects the family as a whole. The three main questions that were asked while creating this study included what the average level of conflict was between marital, parent-child and sibling relationships after a year, how many family relationships become distressed and remain distressed throughout the year and, lastly, what the usual trajectory of conflict was in year one of treatment. They measured the amount of marital adjustment, parent-child conflict and the sibling conflict the family experienced in the one year. The hypothesis of the study was that the couples in the families would demonstrate a decrease in marital satisfaction and that there would be an increase conflict in the parent-child relationships over the first year of the pediatric cancer treatment after diagnosis. Additionally, the researchers hypothesized that the sibling conflict would be stable. This study worked to measure how much family relationships changed during treatment and how families could better their relationships individually.
The scientist acknowledged the work of similar studies that all had acquiescent conflicting results. Some of the studies that were conducted had an increase in marital distress, either in the beginning or end of treatment, and some results showed no difference from the control group. Unfortunately, only two studies examined sibling conflict and there was no longitudinal empirical studies of the conflict between parents and their children. The researchers also acknowledged the limitations of their methods in this study, mostly with the likely variability that would occur. They decided that these variabilities would decreases the most by doing the study in the first year after diagnosis and by using a growth curve model, instead of the auto-regressive model used in all of the past studies.
Method
This particular study included one hundred and fifty nine english speaking families that had newly diagnosed children with either cancer or a central nervous system tumor between the ages of two and eighteen. Almost eighty four percent of the families were White/Caucasian, with the small rest of the minority being Hispanic, Black/African American, Asian, American Indian, or other. The researchers required a caregiver be identified and most caregivers were women and in a marital relationship. To make sure the study was ethical, the Institutional Review Boards at the University of Washington and Vanderbilt University reviewed and approved this study’s procedures and methods before they were conducted.
In the beginning of the study, a questionnaire was given to each caregiver to fill out and a packet was sent out monthly for follow up questions as time went on. Some participants began to not send in their data regularly, due to the distraction of treatment. Also, there was a in-person check-in with each family that was conducted three months after the diagnosis in order to collect physiological and observational data. In each packet, questions on parent-child conflict and sibling conflict were all asked. The study used the Intensity of Treatment Rating when asking the families the severity of treatment the child, in each family, was going through with a one (least intensive) to four (most intensive) scale. Furthermore, martial adjustment was measured with the Dyadic Adjustment scale, ranging from mildly distressed to severely distressed. Parenting Questionnaires were used to evaluate parent-child conflict with a five point scale to rate questions asked about the nature of the relationships. Lastly, sibling conflict was measured through the Sibling Relationship Questionnaire that included nine items that evaluated frequency of conflict and three that evaluated antagonism in the relationship. This data was used to conclude and measure the distress levels in each relationship. The researchers agreed that there would most likely be some variability in each results. They created cut-offs to classify what “distress” was for marital adjustment, classifying distress as one standard deviation above the mean for sibling and parent-child conflict. Also, they used multilevel modeling, models with data at more than one level, to analyze repeated measures and also within-family and between-family measures throughout the twelve months.
Results
The conflict results of all categories had similar ending results that followed the hypothesis considerably. The marital adjustment decreased between months five and six and researchers found that most of the marital distress was at months three and six. Parent-child conflict had low to average results with an increased conflict after three months. The distress level of families was the most reported at months ten and eleven and the least at months one and seven. Like the marital adjustment results, the parent-child results showed stability in year one of treatment with some variability. Overall, marital dissatisfaction and parent-child conflict increased sporadically throughout the year, while the sibling conflict increased in the later months of the year. All types of relationships measured mostly showed stability that was more prominent than the conflict data.
Discussion
This study on families affected by pediatric cancer treatment demonstrated how relationships can remain stable even when experiencing the stress of the diagnosis and treatment of cancer. Most of the relationships were generally unchanging throughout the whole year, although this is the first study to show clinical levels of distress in couples. While the average amount of couples did not disclose a significant amount of marital distress, there was an elevated amount of mild, moderate, and severe distress in the first three months. The authors suggested that the families go to therapy in the earlier months after diagnosis, as that is when the stress levels are the most prominent. Comparatively, parent-child relationships seemed to have greater distress in the late months rather than the earlier months. The authors reasoned that this had to do with parents not wanting to have conflict with their children so soon after the diagnosis and then returning back to normal after time goes by. The researchers recommended collecting data more intently after the diagnosis and during treatment in future studies, which could create more honest responses. Also, collecting the viewpoints of the children and not just the caregiver could give a better insight of the relationships. Similarly, a more diverse group of participants could create better findings of a bigger population in future studies. Families with disparate ethnic backgrounds could experience different reactions to the situation that could affect their relationships differently. The researchers also suggested that in the future, it would be useful to focus on the time span of each relationship and to also be better prepared for the variabilities that occur. Contrastingly, the strengths of this study included this being the first study on this topic to use a growth model that bettered the results and created more efficient information. In conclusion, most relationships retained a healthy relationships with only slight conflict throughout the year long study. Overall, it was demonstrated that the minimal conflict seen in this study did not cause harmful effects in the relationships. This study has shown that families going through the stress of having a child enduring pediatric cancer treatment are able to keep stable relationships. A person’s healthy well-being, in the social aspect, is possible during stressful situations and the distress of different relationships could be due to outside influences and already formed stressors. Also, other outside forces, such as religious beliefs, support groups and exercise, that were not measured could have lead to the decrease in stress during some months. This experience could have allowed individuals in each family to have a positive experience with these stressors and allowed them to learn new skills on how to cope better. Developing a study like this can encourage families to possibly have healthier relationships during upsetting and stressful situations such as pediatric cancer.
